International Buddhist Society :: Three Refuges or Five Precepts Registration

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INTERNATIONAL BUDDHIST SOCIETY

TAKING THE THREE REFUGES/ FIVE PRECEPTS REGISTRATION

Fields marked with * are required

First Name*:

Last Name*:

Chinese Name:

Education:

Years in Canada:

Social Insurance No:

Driver's License No:

Nationality:

Gender:

Male Female

Address:

Home Phone*:

Cell Phone:

Email:

Languages:

English

Cantonese

Mandarin

All of above

Others

Ceremony Date:

Would you like to join our volunteer team?

Yes No

Reason for taking refuges/ Five precepts:

Emergency contact name*:

Emergency contact phone*:

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